True Local Recurrences or New Primary Tumors after Breast-Conserving Surgery and Radiation Therapy

Background& Aims: True local recurrences(TR)and new primary tumors(NP)in the conserved breast after breast-conserving surgery with radiation therapy are determined by the initial surgical margin, the location of recurrent tumors and the histological consistency between initial tumors and recurrent tumors. Methods: A total of 15 patients with breast recurrence out of a group of 389 women with breast cancer who underwent breast-conserving therapy between 1991 and 2003 were included in this study. The biological differences between TR and NP were examined. Results: Eight patients had TR, and seven had NP. The disease-free interval was 34.6 months in the TR group and 94.1 in the NP group. Breast-free survival was significantly better in the NP group than the TR group. The accumulated 10-year overall survival after salvage surgery in patients with TR or NP tumors was 85.1％. The accumulated overall survival after salvage surgery was better in the NP group than the TR group. Conclusions: Patients with NP tumors have a favorable prognosis compared to those with TR tumors. It is important to determine the type of breast recurrence in order to accurately predict the prognosis of patients with breast recurrence

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma : A Case Report

We present a rare case of a 26-year old woman with diffuse sclerosing variant of papillary thyroid carcinoma. The patient was referred to our hospital with diffuse enlargement of the thyroid accompanied with palpable bilateral cervical lymph nodes. Ultrasonography showed a heterogeneous pattern with ill-defined hypoechoic areas in both thyroid lobes. There were multiple small punctate echogenic foci. Fine-needle aspiration cytology revealed typical signs of papillary carcinoma. The patient underwent a total thyroidectomy using a bilateral modified neck dissection. Pathological findings demonstrated diffuse involvement and continuous infiltration of the tumors to both thyroid lobes, lymph nodes and cervical soft tissue. Postoperatively, 100 mCi of 131I was administrated to the small amount of residual thyroid tissue. The patient is free from recurrence one year after the operation

Circulating tumor cells in breast cancer patients treated by neoadjuvant chemotherapy: A Meta-analysis

BACKGROUND: We conducted a meta-analysis in nonmetastatic breast cancer patients treated by neoadjuvant chemotherapy (NCT) to assess the clinical validity of circulating tumor cell (CTC) detection as a prognostic marker. METHODS: We collected individual patient data from 21 studies in which CTC detection by CellSearch was performed in early breast cancer patients treated with NCT. The primary end point was overall survival, analyzed according to CTC detection, using Cox regression models stratified by study. Secondary end points included distant disease-free survival, locoregional relapse-free interval, and pathological complete response. All statistical tests were two-sided. RESULTS: Data from patients were collected before NCT (n = 1574) and before surgery (n = 1200). CTC detection revealed one or more CTCs in 25.2% of patients before NCT; this was associated with tumor size (P < .001). The number of CTCs detected had a detrimental and decremental impact on overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P < .001), but not on pathological complete response. Patients with one, two, three to four, and five or more CTCs before NCT displayed hazard ratios of death of 1.09 (95% confidence interval [CI] = 0.65 to 1.69), 2.63 (95% CI = 1.42 to 4.54), 3.83 (95% CI = 2.08 to 6.66), and 6.25 (95% CI = 4.34 to 9.09), respectively. In 861 patients with full data available, adding CTC detection before NCT increased the prognostic ability of multivariable prognostic models for overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P = .008). CONCLUSIONS: CTC count is an independent and quantitative prognostic factor in early breast cancer patients treated by NCT. It complements current prognostic models based on tumor characteristics and response to therapy